raffinose and Blood-Loss--Surgical

A number of factors have combined to drive the interest in developing blood substitutes. These include the time-dependent decrement in stored blood biochemistry, the general shortage of the blood supply, and public awareness of the risks associated with allogeneic transfusions. Current literature on different blood substitutes was reviewed. The aim of this article is to help the reader understand the necessity of blood substitutes and to briefly describe blood substitutes that are in clinical trials. The need for oxygen-carrying blood substitutes is the driving force in multiple clinical trials. More research is needed to develop alteratives to allogeneic blood transfusion that are free of complications.

Topics: Aortic Aneurysm, Abdominal; Blood Loss, Surgical; Blood Substitutes; Blood Transfusion; Clinical Trials as Topic; Hemoglobins; Humans; Male; Middle Aged; Needs Assessment; Raffinose; Research; Risk Factors; Transfusion Reaction; Treatment Outcome

Topics: Animals; Blood Loss, Surgical; Blood Substitutes; Clinical Trials as Topic; Fluorocarbons; Hemoglobins; History, 19th Century; History, 20th Century; Humans; Hydrocarbons, Brominated; Raffinose

Hepatic vascular exclusion allows the performance of major hepatic resections with minimal intraoperative blood loss. We have previously shown that normothermic ischemia can be tolerated by a healthy liver for up to 90 minutes, and this period is increased to 4 hours if the liver is cooled to 4 degrees C using University of Wisconsin solution.. This study assessed whether these techniques could be successfully applied for patients requiring resection of a diseased liver, which is more sensitive to ischemic damage. Between July 1990 and May 1994, 12 patients (6 men, 6 women; mean age, 57.8 years) in whom the planned hepatic resection was believed to require hepatic vascular exclusion for more than 1 hour were treated with perfusion with the University of Wisconsin solution. The surgical procedures were right hepatectomy (one patient), extended right hepatectomy (seven patients), and extended left hepatectomy (four patients). The underlying hepatic disease was cirrhosis or severe fibrosis with hepatocellular carcinoma (four patients), cholestasis (due to cholangiocarcinoma and biliary stricture, one patient each), and more than 30 percent steatosis after treatment of hepatic metastases with chemotherapy (six patients). The University of Wisconsin solution that had been cooled to 4 degrees C was perfused through a cannula placed in the portal vein or the hepatic arterial branch of the segment to be resected, but with flow directed toward the liver that should be retained and effluent fluid drained through a cavotomy. Before reperfusion, the liver was rinsed with Ringer's lactate solution, which was also 4 degrees C.. The mean duration of hepatic ischemia was 121 minutes (range, 65 to 250 minutes), and venovenous bypass was used in three cases. The mean amount of blood transfused intraoperatively was 4.3 +/- 4 U; four cases required no transfusion. One patient died on postoperative day seven of portal vein thrombosis. The median hospital stay was 21 days (range, 12 to 56 days). Postoperative complications consisted of pneumonia (one patient), liver insufficiency (one patient, who recovered spontaneously), and subphrenic abscess (one patient). The postoperative tests of hepatic function were altered to the same degree as that seen after hepatic vascular exclusion of less than 1-hour duration in healthy livers. All patients who left the hospital were alive at 1 year.. Cooling of the hepatic parenchyma allowed us to perform major hepatic resection in patients with diseased livers using hepatic vascular exclusion for longer than 1 hour without increased morbidity or mortality. However, because of particular difficulties due to the size or location of the lesions, the application of these new techniques should only be considered for the largest and most complex hepatic resections for which hepatic vascular exclusions longer than 1 hour are foreseen.

Topics: Adenosine; Adult; Aged; Allopurinol; Blood Loss, Surgical; Cryopreservation; Female; Follow-Up Studies; Glutathione; Hepatectomy; Hepatic Artery; Humans; Hypothermia, Induced; Insulin; Liver; Liver Circulation; Liver Diseases; Male; Middle Aged; Organ Preservation Solutions; Portal Vein; Raffinose; Reperfusion Injury; Tissue Preservation

Topics: Adenosine; Allopurinol; Blood Loss, Surgical; Constriction; Embolism, Air; Follow-Up Studies; Glutathione; Hepatectomy; Hepatic Veins; Humans; Hypothermia, Induced; Insulin; Ischemia; Ligation; Liver Circulation; Liver Diseases; Liver Failure; Liver Neoplasms; Organ Preservation Solutions; Perfusion; Portal Vein; Raffinose; Survival Rate; Time Factors; Tissue Preservation; Vena Cava, Inferior

Topics: Adenosine; Allopurinol; Blood Coagulation Disorders; Blood Loss, Surgical; Blood Platelets; Glutathione; Humans; Insulin; Liver Transplantation; Organ Preservation; Organ Preservation Solutions; Platelet Aggregation; Raffinose; Reperfusion; Thrombocytopenia